Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes

We analyzed the effect of changes in health care provider reimbursement mechanisms on pregnancy outcomes. In 2014, the Colombian government implemented a policy that eased the requirements for young adults to keep their health coverage after turning 18. Given the mandatory nature of prenatal care an...

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Tipo de recurso:
Fecha de publicación:
2023
Institución:
Universidad del Rosario
Repositorio:
Repositorio EdocUR - U. Rosario
Idioma:
spa
OAI Identifier:
oai:repository.urosario.edu.co:10336/42026
Acceso en línea:
https://repository.urosario.edu.co/handle/10336/42026
Palabra clave:
Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities.
Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities
Rights
License
Attribution-NonCommercial-NoDerivatives 4.0 International
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oai_identifier_str oai:repository.urosario.edu.co:10336/42026
network_acronym_str EDOCUR2
network_name_str Repositorio EdocUR - U. Rosario
repository_id_str
dc.title.none.fl_str_mv Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
title Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
spellingShingle Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities.
Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities
title_short Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
title_full Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
title_fullStr Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
title_full_unstemmed Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
title_sort Unpacking healthcare insurance and financing mechanisms: impacts on pregnancy and birth outcomes
dc.contributor.advisor.none.fl_str_mv Rodríguez Lesmes, Paul Andrés
dc.subject.none.fl_str_mv Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities.
topic Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities.
Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities
dc.subject.keyword.none.fl_str_mv Insurance
Pregnancy
Health providers
Healthcare billing
Difference-in-discontinuities
description We analyzed the effect of changes in health care provider reimbursement mechanisms on pregnancy outcomes. In 2014, the Colombian government implemented a policy that eased the requirements for young adults to keep their health coverage after turning 18. Given the mandatory nature of prenatal care and delivery provision in the country, being insured or not does not affect the admission of pregnant women, but it does impact billing processes for health providers as the responsible payment entity changes. Our study exploits the temporal variation and policy-induced discontinuity by employing a differences-in-discontinuities design. We found that the policy decreased the non-affiliation rate by almost 20%. However, our results indicate that non-affiliation (or, equivalently, health service providers billing the state instead of insurers) is associated with a 44 percentage point decrease in the occurrence of preterm births, as well as a reduction in the likelihood of low birth weight and height.
publishDate 2023
dc.date.created.none.fl_str_mv 2023-12-15
dc.date.accessioned.none.fl_str_mv 2024-01-18T16:06:52Z
dc.date.available.none.fl_str_mv 2024-01-18T16:06:52Z
dc.type.none.fl_str_mv bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.document.none.fl_str_mv Trabajo de grado
dc.type.spa.none.fl_str_mv Trabajo de grado
dc.identifier.uri.none.fl_str_mv https://repository.urosario.edu.co/handle/10336/42026
url https://repository.urosario.edu.co/handle/10336/42026
dc.language.iso.none.fl_str_mv spa
language spa
dc.rights.*.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.acceso.none.fl_str_mv Abierto (Texto Completo)
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
Abierto (Texto Completo)
http://creativecommons.org/licenses/by-nc-nd/4.0/
http://purl.org/coar/access_right/c_abf2
dc.format.extent.none.fl_str_mv 50 pp
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.spa.fl_str_mv Universidad del Rosario
dc.publisher.department.spa.fl_str_mv Facultad de Economía
dc.publisher.program.spa.fl_str_mv Maestría en Economía
institution Universidad del Rosario
dc.source.bibliographicCitation.none.fl_str_mv Atehortúa, S. C. and Palacio-Mejía, L. S. (2014). Impacto del seguro de salud subsidiado en el acceso a la citología cervical en Medellín, Colombia. Revista de Salud Pública, 16:522–533.
Barros, F. C., Victora, C. G., Barros, A. J., Santos, I. S., Albernaz, E., Matijasevich, A., Domingues, M. R., Sclowitz, I. K., Hallal, P. C., Silveira, M. F., et al. (2005). The challenge of reducing neonatal mortality in middle-income countries: findings from three brazilian birth cohorts in 1982, 1993, and 2004. The Lancet, 365(9462):847–854.
Bowser, D., Gupta, J., and Nandakumar, A. (2016). The effect of demand-and supply- side health financing on infant, child, and maternal mortality in low-and middle-income countries. Health Systems & Reform, 2(2):147–159.
Buchmueller, T. C., Grumbach, K., Kronick, R., and Kahn, J. G. (2005). The effect of health insurance on medical care utilization and implications for insurance expansion: A review of the literature. Medical Care Research and Review, 62(1):3–30.
Card, D., Fenizia, A., and Silver, D. (2018). The Health Effects of Cesarean Delivery for Low-Risk First Births. NBER Working Papers 24493, National Bureau of Economic Research, Inc.
Carranza, J. E., Álvaro J. Riascos, and Serna, N. (2015). Poder de mercado, contratos y resultados de salud en el sistema de salud colombiano entre 2009 y 2011. Borradores de Economia 918, Banco de la Republica de Colombia.
Cattaneo, M. D., Idrobo, N., and Titiunik, R. (2019). A practical introduction to regression discontinuity designs: Foundations. Cambridge University Press.
Comfort, A. B., Peterson, L. A., and Hatt, L. E. (2013). Effect of health insurance on the use and provision of maternal health services and maternal and neonatal health outcomes: a systematic review. Journal of health, population, and nutrition, 31(4 Suppl 2):S81.
Cunningham, S. (2021). Causal inference: The mixtape. Yale university press.
Currie, J. and Gruber, J. (1996). Health insurance eligibility, utilization of medical care, and child health. The Quarterly Journal of Economics, 111(2):431–466.
de Elejalde, R. and Giolito, E. (2019). More hospital choices, more C-sections: evidence from Chile. (12297).
Dirección de Regulación de la Operación del Aseguramiento en Salud, Riesgos Laborales y Pensiones (2015). Población pobre no asegurada: Metodología para su estimación y resultados obtenidos. Technical report, Ministerio de Salud y Protección Social.
Ellis, R. P. and McGuire, T. G. (1986). Provider behavior under prospective reimbursement: Cost sharing and supply. Journal of Health Economics, 5(2):129–151.
Epstein, A. M. and Newhouse, J. P. (1998). Impact of medicaid expansion on early prenatal care and health outcomes. Health Care Financing Review, 19(4):85.
Foo, P. K., Lee, R. S., and Fong, K. (2017). Physician Prices, Hospital Prices, and Treatment Choice in Labor and Delivery. American Journal of Health Economics, 3(3):422–453.
Gaviria, A. and Palau, M. d. M. (2006). Nutrición y salud infantil en Colombia: determinantes y alternativas de política. Coyuntura Económica.
Giedion, U., Alfonso-Sierra, E., Díaz, Y., and Savedoff, W. (2007). The Impact of Subsidized Health Insurance on Access, Utilization and Health Status in Colombia.
Giedion, U., Díaz, B. Y., Alfonso, E. A., and Savedoff, W. D. (2009a). The impact of subsidized health insurance on health status and on access to and use of health services. From Few to Many, page 47.
Giedion, U., Panopoulou, G., and Gómez-Fraga, S. (2009b). Diseño y ajuste de los planes explícitos de beneficios: el caso de Colombia y México. CEPAL.
Goin, D. E., Casey, J. A., Kioumourtzoglou, M. A., Cushing, L. J., and Morello-Frosch, R. (2021). Environmental hazards, social inequality, and fetal loss: implications of live-birth bias for estimation of disparities in birth outcomes. Environmental Epidemiology, 5(2).
Grabowski, D. C., Afendulis, C. C., and McGuire, T. G. (2011). Medicare prospective payment and the volume and intensity of skilled nursing facility services. Journal of health economics, 30(4):675–684.
Grembi, V., Nannicini, T., and Troiano, U. (2016). Do Fiscal Rules Matter? American Economic Journal: Applied Economics, 8(3):1–30.
Guldi, M. and Hamersma, S. (2023). The effects of pregnancy-related medicaid expansions on maternal, infant, and child health. Journal of Health Economics, 87:102695.
Handler, A. and Rosenberg, D. (1992). Improving pregnancy outcomes: public versus private care for urban, low-income women. Birth, 19(3):123–130.
Hernández-Martínez, A., Martínez-Galiano, J. M., Rodríguez-Almagro, J., Delgado- Rodríguez, M., and Gómez-Salgado, J. (2019). Evidence-based birth attendance in spain: private versus public centers. International journal of environmental research and public health, 16(5):894.
Jones, A. and Zanola, R. (2001). Agency and Health Care, pages 165–188. Springer US, Boston, MA.
Kosecoff, J., Kahn, K. L., Rogers, W. H., Reinisch, E. J., Sherwood, M. J., Rubenstein, L. V., Draper, D., Roth, C. P., Chew, C., and Brook, R. H. (1990). Prospective payment system and impairment at discharge: the quicker-and-sicker’ story revisited. Jama, 264(15):1980–1983.
Lee, D. S. and Card, D. (2008). Regression discontinuity inference with specification error. Journal of Econometrics, 142(2):655–674. The regression discontinuity design: Theory and applications.
Londoño, J. L. and Frenk, J. (1997). Pluralismo estructurado: Hacia un modelo innovador para la reforma de los sistemas de salud en América Latina. IDB Publications (Working Papers) 6127, Inter-American Development Bank.
Long, S. H. and Marquis, M. S. (1998). The effects of Florida’s medicaid eligibility expansion for pregnant women. American Journal of Public Health, 88(3):371–376.
López, I. D. L., Arbeláez, J. U., and Castaño, D. N. (2006). Aplicación de la Teoría de Restricciones (TOC) a la gestión de facturación de las Empresas Sociales del Estado, ESE. Innovar. Revista de Ciencias Administrativas y Sociales, 16(27):91–100.
Miller, G., Pinto, D., and Vera-Hernández, M. (2013). Risk protection, service use, and health outcomes under Colombia’s health insurance program for the poor. American Economic Journal: Applied Economics, 5(4):61–91.
Pfutze, T. (2015). Does access to health insurance reduce the risk of miscarriages? evidence from mexico’s seguro popular. Latin American Economic Review, 24:1–10.
Prada, L. (2004). Aseguramiento en los regímenes contributivo y subsidiado, e impacto en los prestadores de servicios. Revista de Salud Pública, 6(1):1–27.
Ray, W. A., Mitchel Jr, E. F., and Piper, J. M. (1997). Effect of medicaid expansions on preterm birth. American Journal of Preventive Medicine, 13(4):292–297.
Smith, P. C., Stepan, A., Valdmanis, V., and Verheyen, P. (1997). Principal-agent problems in health care systems: an international perspective. Health policy, 41(1):37–60.
Trujillo, A. J., Portillo, J. E., and Vernon, J. A. (2005). The impact of subsidized health insurance for the poor: evaluating the colombian experience using propensity score matching. International journal of health care finance and economics, 5:211–239.
Upegui, S. F. (2020). Generalidades de la facturación en salud y sus problemas en la operación. B.S. thesis, Escuela de Derecho y Ciencias Políticas.
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spelling Rodríguez Lesmes, Paul Andrésda4c21f4-2484-4ffe-96d4-1394f6a3b38fLeal Gamba, Javier AlexanderMagíster en EconomíaMaestríaFull timec4dfa3ce-3dbe-4e14-9365-3aef3c5a1955-12024-01-18T16:06:52Z2024-01-18T16:06:52Z2023-12-15We analyzed the effect of changes in health care provider reimbursement mechanisms on pregnancy outcomes. In 2014, the Colombian government implemented a policy that eased the requirements for young adults to keep their health coverage after turning 18. Given the mandatory nature of prenatal care and delivery provision in the country, being insured or not does not affect the admission of pregnant women, but it does impact billing processes for health providers as the responsible payment entity changes. Our study exploits the temporal variation and policy-induced discontinuity by employing a differences-in-discontinuities design. We found that the policy decreased the non-affiliation rate by almost 20%. However, our results indicate that non-affiliation (or, equivalently, health service providers billing the state instead of insurers) is associated with a 44 percentage point decrease in the occurrence of preterm births, as well as a reduction in the likelihood of low birth weight and height.We analyzed the effect of changes in health care provider reimbursement mechanisms on pregnancy outcomes. In 2014, the Colombian government implemented a policy that eased the requirements for young adults to keep their health coverage after turning 18. Given the mandatory nature of prenatal care and delivery provision in the country, being insured or not does not affect the admission of pregnant women, but it does impact billing processes for health providers as the responsible payment entity changes. Our study exploits the temporal variation and policy-induced discontinuity by employing a differences-in-discontinuities design. We found that the policy decreased the non-affiliation rate by almost 20%. However, our results indicate that non-affiliation (or, equivalently, health service providers billing the state instead of insurers) is associated with a 44 percentage point decrease in the occurrence of preterm births, as well as a reduction in the likelihood of low birth weight and height.50 ppapplication/pdfhttps://repository.urosario.edu.co/handle/10336/42026spaUniversidad del RosarioFacultad de EconomíaMaestría en EconomíaAttribution-NonCommercial-NoDerivatives 4.0 InternationalAbierto (Texto Completo)EL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.http://creativecommons.org/licenses/by-nc-nd/4.0/http://purl.org/coar/access_right/c_abf2Atehortúa, S. C. and Palacio-Mejía, L. S. (2014). Impacto del seguro de salud subsidiado en el acceso a la citología cervical en Medellín, Colombia. Revista de Salud Pública, 16:522–533.Barros, F. C., Victora, C. G., Barros, A. J., Santos, I. S., Albernaz, E., Matijasevich, A., Domingues, M. R., Sclowitz, I. K., Hallal, P. C., Silveira, M. F., et al. (2005). The challenge of reducing neonatal mortality in middle-income countries: findings from three brazilian birth cohorts in 1982, 1993, and 2004. The Lancet, 365(9462):847–854.Bowser, D., Gupta, J., and Nandakumar, A. (2016). The effect of demand-and supply- side health financing on infant, child, and maternal mortality in low-and middle-income countries. Health Systems & Reform, 2(2):147–159.Buchmueller, T. C., Grumbach, K., Kronick, R., and Kahn, J. G. (2005). The effect of health insurance on medical care utilization and implications for insurance expansion: A review of the literature. Medical Care Research and Review, 62(1):3–30.Card, D., Fenizia, A., and Silver, D. (2018). The Health Effects of Cesarean Delivery for Low-Risk First Births. NBER Working Papers 24493, National Bureau of Economic Research, Inc.Carranza, J. E., Álvaro J. Riascos, and Serna, N. (2015). Poder de mercado, contratos y resultados de salud en el sistema de salud colombiano entre 2009 y 2011. Borradores de Economia 918, Banco de la Republica de Colombia.Cattaneo, M. D., Idrobo, N., and Titiunik, R. (2019). A practical introduction to regression discontinuity designs: Foundations. Cambridge University Press.Comfort, A. B., Peterson, L. A., and Hatt, L. E. (2013). Effect of health insurance on the use and provision of maternal health services and maternal and neonatal health outcomes: a systematic review. Journal of health, population, and nutrition, 31(4 Suppl 2):S81.Cunningham, S. (2021). Causal inference: The mixtape. Yale university press.Currie, J. and Gruber, J. (1996). Health insurance eligibility, utilization of medical care, and child health. The Quarterly Journal of Economics, 111(2):431–466.de Elejalde, R. and Giolito, E. (2019). More hospital choices, more C-sections: evidence from Chile. (12297).Dirección de Regulación de la Operación del Aseguramiento en Salud, Riesgos Laborales y Pensiones (2015). Población pobre no asegurada: Metodología para su estimación y resultados obtenidos. Technical report, Ministerio de Salud y Protección Social.Ellis, R. P. and McGuire, T. G. (1986). Provider behavior under prospective reimbursement: Cost sharing and supply. Journal of Health Economics, 5(2):129–151.Epstein, A. M. and Newhouse, J. P. (1998). Impact of medicaid expansion on early prenatal care and health outcomes. Health Care Financing Review, 19(4):85.Foo, P. K., Lee, R. S., and Fong, K. (2017). Physician Prices, Hospital Prices, and Treatment Choice in Labor and Delivery. American Journal of Health Economics, 3(3):422–453.Gaviria, A. and Palau, M. d. M. (2006). Nutrición y salud infantil en Colombia: determinantes y alternativas de política. Coyuntura Económica.Giedion, U., Alfonso-Sierra, E., Díaz, Y., and Savedoff, W. (2007). The Impact of Subsidized Health Insurance on Access, Utilization and Health Status in Colombia.Giedion, U., Díaz, B. Y., Alfonso, E. A., and Savedoff, W. D. (2009a). The impact of subsidized health insurance on health status and on access to and use of health services. From Few to Many, page 47.Giedion, U., Panopoulou, G., and Gómez-Fraga, S. (2009b). Diseño y ajuste de los planes explícitos de beneficios: el caso de Colombia y México. CEPAL.Goin, D. E., Casey, J. A., Kioumourtzoglou, M. A., Cushing, L. J., and Morello-Frosch, R. (2021). Environmental hazards, social inequality, and fetal loss: implications of live-birth bias for estimation of disparities in birth outcomes. Environmental Epidemiology, 5(2).Grabowski, D. C., Afendulis, C. C., and McGuire, T. G. (2011). Medicare prospective payment and the volume and intensity of skilled nursing facility services. Journal of health economics, 30(4):675–684.Grembi, V., Nannicini, T., and Troiano, U. (2016). Do Fiscal Rules Matter? American Economic Journal: Applied Economics, 8(3):1–30.Guldi, M. and Hamersma, S. (2023). The effects of pregnancy-related medicaid expansions on maternal, infant, and child health. Journal of Health Economics, 87:102695.Handler, A. and Rosenberg, D. (1992). Improving pregnancy outcomes: public versus private care for urban, low-income women. Birth, 19(3):123–130.Hernández-Martínez, A., Martínez-Galiano, J. M., Rodríguez-Almagro, J., Delgado- Rodríguez, M., and Gómez-Salgado, J. (2019). Evidence-based birth attendance in spain: private versus public centers. International journal of environmental research and public health, 16(5):894.Jones, A. and Zanola, R. (2001). Agency and Health Care, pages 165–188. Springer US, Boston, MA.Kosecoff, J., Kahn, K. L., Rogers, W. H., Reinisch, E. J., Sherwood, M. J., Rubenstein, L. V., Draper, D., Roth, C. P., Chew, C., and Brook, R. H. (1990). Prospective payment system and impairment at discharge: the quicker-and-sicker’ story revisited. Jama, 264(15):1980–1983.Lee, D. S. and Card, D. (2008). Regression discontinuity inference with specification error. Journal of Econometrics, 142(2):655–674. The regression discontinuity design: Theory and applications.Londoño, J. L. and Frenk, J. (1997). Pluralismo estructurado: Hacia un modelo innovador para la reforma de los sistemas de salud en América Latina. IDB Publications (Working Papers) 6127, Inter-American Development Bank.Long, S. H. and Marquis, M. S. (1998). The effects of Florida’s medicaid eligibility expansion for pregnant women. American Journal of Public Health, 88(3):371–376.López, I. D. L., Arbeláez, J. U., and Castaño, D. N. (2006). Aplicación de la Teoría de Restricciones (TOC) a la gestión de facturación de las Empresas Sociales del Estado, ESE. Innovar. Revista de Ciencias Administrativas y Sociales, 16(27):91–100.Miller, G., Pinto, D., and Vera-Hernández, M. (2013). Risk protection, service use, and health outcomes under Colombia’s health insurance program for the poor. American Economic Journal: Applied Economics, 5(4):61–91.Pfutze, T. (2015). Does access to health insurance reduce the risk of miscarriages? evidence from mexico’s seguro popular. Latin American Economic Review, 24:1–10.Prada, L. (2004). Aseguramiento en los regímenes contributivo y subsidiado, e impacto en los prestadores de servicios. Revista de Salud Pública, 6(1):1–27.Ray, W. A., Mitchel Jr, E. F., and Piper, J. M. (1997). Effect of medicaid expansions on preterm birth. American Journal of Preventive Medicine, 13(4):292–297.Smith, P. C., Stepan, A., Valdmanis, V., and Verheyen, P. (1997). Principal-agent problems in health care systems: an international perspective. Health policy, 41(1):37–60.Trujillo, A. J., Portillo, J. E., and Vernon, J. A. (2005). The impact of subsidized health insurance for the poor: evaluating the colombian experience using propensity score matching. International journal of health care finance and economics, 5:211–239.Upegui, S. F. (2020). Generalidades de la facturación en salud y sus problemas en la operación. 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